Path-breaking Organizational Change: Effective Cancer Treatment through Multi-Center Cooperation

Sometimes organizational change is not even likely to occur when it is required most. The theory of organizational path dependence traces such a lock-in back to an event that triggered self-reinforcing processes making change increasingly difficult. Although more recent conceptualizations of path dependence allow for strategic agency in different phases of the process, the theory is underspecified with regard to the conditions and mechanisms for path-breaking change. In an attempt to increase our understanding of this type of organizational change in general and to elaborate on this theory in particular, we make use of a case of very unlikely organizational change that nevertheless happened: the introduction of the up to now one and only cooperative multi-center organization in the Russian healthcare system. This in-depth study, using among others ethnographic methods, allows us to elaborate a theoretical understanding by specifying path-breaking change as a gradual process in which self-reinforcing mecha...